The Surgical Weight Loss Center at Three Rivers Medical Center is a comprehensive program for the education, treatment, and care of patients with morbid obesity who have had or will undergo weight loss (bariatric) surgery. Treatment of morbid obesity includes not only the surgery and post-operative care, but also extensive medical evaluation, dietary counseling, patient and family education, healthy lifestyle support and yearly follow-up. We believe in the team approach to weight loss surgery.
The Surgical Weight Loss Center Team
- Bariatric Surgeon – Laura Velcu, MD
- Program Coordinator and Dietitian
- Anesthesiologist and anesthetists
- Specialty nurses
- Paramedical personnel
- Financial counselors
- Physical Therapist
According to the Centers for Disease Control and Prevention, nearly two thirds of all U.S. adults are overweight and one third of all U.S. adults are obese. Each year 300,000 deaths are attributed to poor diet and inactivity.
Potential Benefits of Weight Loss Surgery
- Greater than 50% excess weight loss
- The weight stays off, if the patient is committed to life-style change
- Type II diabetes is improved in most patients
- Hypertension improved or resolved
- Normalized or decreased cholesterol and lipids
- Decreased risk of heart attack, stroke and premature death
- Improvement of sleep apnea
- Improvement in gastroesophageal reflux disease (GERD)
- Improvement in joint pain and venous stasis disease
Alternatives to Weight Loss Surgery
Healthy diet and exercise is one of the traditional methods to lose weight. Other alternatives include: weight reduction programs that charge fees to administer the program, medical treatment by a physician and behavioral modification
treatments. Weight loss surgery should only be considered after attempts at traditional weight loss methods have failed.
Qualifications for The Surgical Weight Loss Center
- Age 15-65, male or female
- Willingness to comply with follow-up and diet changes
- Nonsmoker for at least 2 months
- Certain medical conditions and surgeries may make weight loss surgery too risky
- Body Mass Index* (BMI) of 40 to 60 with documented failed medical weight loss efforts
* Body Mass Index is a number derived by using height and weight measurements that gives a general indication if weight falls in a healthy range.
Risks of Weight Loss Surgery
Risks of weight loss surgery will vary for each candidate. Therefore, each person should discuss any possible risks with a physician who is familiar with his/her medical history.
Risks for weight loss surgery may include:
- Surgical risk equivalent to open-heart surgery
- Early Complications: leak, bleeding, infection, anastomotic stricture, blood clots, pulmonary embolism, pneumonia
- Late Complications: ulcer, hernia, bowel obstruction, anemia, B12 and calcium deficiency, dumping syndrome
Special note: many patients have temporary hair loss; some patients complain of excess gas or occasional GI upset in the first few months
Laparoscopic Roux-En-Y gastric bypass
The Roux-en-Y gastric bypass is the most common operation in weight loss surgery, and has been performed successfully laparoscopically (a minimally invasive surgical technique) in tens of thousands of patients. Patients with a BMI of 40-60 qualify, as stated above.
Six tiny incisions, from the size of a pencil eraser to about 1-1/2 inches long, are placed in the abdominal wall, and the operation is performed with the aid of a camera and special laparoscopic instruments. A small pouch is stapled off from the top part of the stomach and a limb of intestine, the Roux limb, is rerouted up to the pouch.
Most patients who receive the laparoscopic gastric bypass surgery recover from the operation very quickly. One may return to full activities in less than a month.
The gastric bypass surgery works in three ways. First, the pouch restricts the volume one can eat in a meal to about 1 oz. Second, the Roux limb is somewhat malabsorptive. Third, the operation "tricks" the body into wanting to lose weight; normally, the body goes into starvation mode when on a diet.
Active weight loss continues from 6 months to over 18 months. After approximately one year most patients have reached their lowest weight.
Open gastric bypass
The procedure is technically similar to the laparoscopic gastric bypass with similar long-term benefits, but carries an increased risk of hernia and wound infections. The operation is performed through an incision 6-8 inches long in the upper abdomen. The recovery period for most patients may be longer than with the laparoscopic operation.
Most laparoscopic patients are discharged from the hospital 2-3 days after surgery. A Patient Controlled Analgesia (PCA) pump is used for pain control while in the hospital. Perioperative antibiotics, heparin injections to prevent blood clots and walking as soon as possible after surgery are essential. An x-ray study of your pouch (an upper GI) is
performed the day after surgery to ensure that no leaks exist.
Patients are scheduled for a post operative visit with the doctor a few days after surgery, one month after surgery, 3 months, 6 months, and 12 months after surgery, then annually for life.
Your New Diet
After surgery, you will slowly progress from no concentrated sweets (NCS) clear liquids to a regular textured NCS/low fat diet. You will always need to take protein and vitamin supplements to maintain a healthy nutritional status. Nutrition counseling is available on an individual basis as well as during group meetings.
Exercise is critical not only to maximize weight loss but also to improve your cardiovascular health. We recommend that you begin an aerobic exercise routine, such as brisk walking or swimming, even before surgery.
You lose fat but not skin. After weight loss is complete (about one year), many patients elect to have the excess skin hanging below the waist removed with an operation called a panniculectomy.
Other plastic surgery options include: removal of excess skin on the arms, neck, thighs, as well as breast and buttock lifts.
Studies have shown that positive results from weight loss surgery correlate with support group involvement. One pre-operative attendance at a weight loss surgery support group is expected. Monthly support group attendance post-operatively is required.
The support group meets the 3rd Tuesday of every month at Three Rivers Medical Center at 6:00 p.m. Call (606) 638-3813 for more information.
Female patients are advised to wait 12 to 18 months after a gastric bypass before becoming pregnant.
Authorization for weight loss surgery must be obtained from your insurance company prior to scheduling surgery. Each insurance company has different requirements. Physician documentation of morbid obesity to include height and weight over a three year period of time is one example. Documented physician supervised weight loss efforts for six months prior to surgery is another. The members of the Surgical Weight Loss Center team are here to assist you through the course of obtaining insurance precertification.
STEPS TO WEIGHT LOSS SURGERY
Contact your insurance company for specific policy information on weight loss surgery. All insurance pre-certifications must be completed before weight loss surgery is scheduled. If you have questions, concerns or need assistance, call The Surgical Weight Loss Center at (606) 638-3813.
Call (606) 638-3813 for an appointment. Separate appointments for initial evaluations will be scheduled with the Program Coordinator, Registered Dietitian and Dr. Laura Velcu.
Attendance at the monthly support group meeting is required unless prior arrangements are made. The six (6) month supervised weight reduction requirement can be met by attending the support group.
A complete medical examination including: lab work, EKG, ultrasound of the gallbladder and chest x-ray may be required after your initial appointment with Dr. Velcu.
Medical clearance by a cardiologist or internist is required for surgery.
Preoperative appointments with Dr. Velcu, the Program Coordinator and Registered Dietitian will be scheduled, along with a pre-anesthesia exam. A tour of the hospital facilities can be scheduled upon request.
Weight Loss Surgery
ABOUT DR. VELCU
Three Rivers Medical Center Weight Management Program Surgeon
Laura Velcu, M.D., graduated from the Carol Davila School of Medicine, Bucharest Romania in 1996. She completed surgical residency training at Nassau University Medical Center and bariatric surgery at Cleveland Clinic, followed by a fellowship in advanced laparoscopy also at the Cleveland Clinic. Dr. Velcu joined the General Surgery staff in 2005 with a special interest in bariatric surgery.
Dr. Velcu is certified in surgery by the American Board of Surgery and holds professional memberships in the American Medical Association, American College of Surgeons – Diplomat Member, Society of American Gastrointestinal Endoscopic Surgeons, and American Society of Bariatric Surgery.
She is actively involved with research in the field of bariatric surgery.